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SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The SARS-CoV2 virus is well known for causing atypical pneumonia in addition to other symptoms Various neurological symptoms have been reported including anosmia, headaches, and stroke like symptoms Here we report a case of a critically ill patient who developed encephalopathy with evidence of multiple bilateral acute strokes CASE PRESENTATION: 68-year-old African American male with no significant past medical history presented with shortness of breath, cough, and fever He was tested positive for COVID-19 Patient quickly desaturated after admission requiring intubation and ICU care During his hospital course, he developed severe renal injury which required hemodialysis Despite daily dialysis in attempt to correct uremia and cessation of all sedations, patient remained minimally responsive CT head without contrast was unremarkable for any acute process Despite improvement in his respiratory status and azotemia, patient remained encephalopathic, unable to be extubated He was subsequently treated empirically with Keppra for possible subclinical seizures and methylphenidate for neurostimulation, no improvement was seen Due to the hospital protocol to limit exposure, our patient was one of the first in our hospital to receive a brain MRI after 29 days of hospitalization, which revealed numerous small areas of restricted diffusion throughout the centrum semiovale bilaterally compatible with extensive small acute infarct There was also an acute infarct adjacent to the frontal horn Based on the locations of the infarcts, they were determined to be most likely ischemic in nature The patient remained intubated in the ICU with guarded prognosis without improvement in his status, he later entered hospice care as per family’s wishes DISCUSSION: The neurological manifestations of SARS-CoV2 virus vary According to a series of 13 cases studied showed 2 of 13 patients with brain MRI had single acute ischemic strokes (3) Our case showed multiple bilateral infarcts on MRI, which has scarcely been reported It was concluded that his encephalopathy was related to these cerebral infarcts The varied coagulopathy features seen in COVID patients is well known and cases of microthrombi have been reported Our patient was given full dose anticoagulation after admission but, altered mentation made extubating impossible CONCLUSIONS: Our patient was able to fight COVID pneumonia but incurred extra pulmonary consequences This presentation emphasizes early MRI should be done as reversible causes may be ruled out Acute CVA should be a top differential in unexplained encephalopathy This case brings to light that although it is possible for patients, even the most severe cases who require intubation, to fight this atypical pneumonia, they can rapidly develop extra-pulmonary complications which if goes unrecognized can leave lethal penalties Reference #1: Avula A, Nalleballe K, Narula N, et al COVID-19 presenting as stroke [published online ahead of print, 2020 Apr 28] Brain Behav Immun 2020;S0889-1591(20)30685-1 doi:10 1016/j bbi 2020 04 077 Reference #2: Pleasure SJ, Green AJ, Josephson SA The Spectrum of Neurologic Disease in the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic Infection: Neurologists Move to the Frontlines JAMA Neurol Published online April 10, 2020 doi:10 1001/jamaneurol 2020 1065 Reference #3: Helms J, Kremer S, Merdji H, et al Neurologic Features in Severe SARS-CoV-2 Infection New England Journal of Medicine 2020 doi:10 1056/nejmc2008597 DISCLOSURES: No relevant relationships by Padmini Giri, source=Web Response No relevant relationships by Gloria Hong, source=Web Response No relevant relationships by Han Lam, source=Web Response No relevant relationships by DANYAL TAHERI ABKOUH, source=Web Response
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